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NYS Coalition for Children’s Behavioral Health Services
2017 Full Membership MeetingFebruary 1, 2017
State Budget Details of Interest
Program 2016 Amt 2017 AmtCommunity Schools $100 million +$50 million6 New Children’s Services $7.5 million* -0-Children’s Transformation Funds $10 million* -0-Human ServicesCOLA0.2% 0.8% ($9;8 million)Minimum Wage $800,000.00 $3.5 millionStatewide Health Care Transformation $195 m/$30 m $500 m/$30 mNICIP $100 m -0-RTF pilot projects -0- $5 mAPG extender June 2018 March 2020 w/ VBP targets*proposed and budgeted but not spent
Anticipated Health/MedicaidPriorities of the Legislature
Extend taxes to fill deficit (millionaires tax and HCRA)Medicaid continues to comply with Global Cap; Executive Authority to address any federal changes w/o Legislature$500 million for Health Care Transformation FundMinimum Wage/WorkforceRegulatory Modernization Team
Our Proposed Priorities
Workforce:minimum wage only $3.5 million0.8% COLA delayed to save $9.8 millionDOL Overtime rule not fundedREQUEST $50.5 million (OPWDD asking for $45 million)REQUEST that 25% of the $1.08 Billion available for behavioral health workforce development under DSRIP set-aside for community based providersCapital:Expand CBO share of Statewide Health Facility Transformation Funding to $125m (25% of the proposed $500 m) and add other licensed behavioral health providersCapacity: Restore the children’s unspent SPA and transformation funding but use to expand capacity NOW ($17.5 million)
Release $17.5m Budgeted but not Spent to Address ImmediateCapacityNeeds
While we wait for CMS, the service system remains stagnant, while Health Homes for Children seek to place children and youth into care and treatmentHire, train and credential 1,000 new Family Peer AdvocatesHire, train and develop a credential for 500 new Peer Youth AdvocatesTrain and credential to Evidence Based Practices (EBPs) for other licensed professionals, hire necessary supervisors and pay fees for EBPsAdd 20 crisis intervention teams statewideAdd outreach and engagement to homeless families to link to Health HomesSupport clinic recruitment and retention with grants to add staff/reduce waiting lists
Fund theWorkforceNeeds
Mental health provider associations have agreed to request $50.5 million to fund the workforce expenses related to minimum wage, overtime rule and general cost of living adjustmentsThe mental health provider associations have agreed to request that 25% of the available DSRIP funds for behavioral health workforce development be set-aside for community-based organizationsThe budget provides only $3.5 million and doesn’t fund a 0.8% statutory COLA (saves $9.8 million in OMH budget and $40 million across the “O” agencies)MORE grassroots advocacy needed – discuss postcards
Access to Capital/Transformation Funding
Last year, successful advocacy set a precedent with a $30 million carve-out in the Statewide Healthcare Transformation fund. The $30 million was part of $195 million pool (15%)This year another $30 million is proposed, but it is only 6% of the a $500 million allocation.We are setting a 25% minimum target for this and any other funds being made available to hospitals, nursing homes and other providers.Therefore: request a $125 million set aside in the Statewide Healthcare Transformation FundSeparate effort to add RTFs as eligible applicants
What Advocacy Can you DO?
We will distribute a document on our top 3 priorities and share via thelistserveUse the document to either:Mail to legislators with a cover letter asking your legislators for specific action during the budget negotiations (Andrea will distribute template cover letter too)Schedule visits with legislators in your home town to talk about the budget and the need for their support of our agenda
Status of Applications and negotiations with CMS
Seeking Clarify for the Field ~ an “AHA” Moment for All Our Listeners
1115 Waiver Amendment for Children’s Services
The state team assured the Kids’ MRT Subcommittee that they remain committed to the redesign, but will not submit the 1115 waiver amendment to authorize the transition of exempt kids into Medicaid Managed Care until they determine the expectations of the new CMS staff.Para-phrased Excerpt from DRAFT 1115:The State is submitting this amendment to itscurrent1115 New York Medicaid Redesign Team Waiver to create a children’s model of care that enables qualified Managed Care Organizations (MCOs) in Mainstream Medicaid Managed Care (MMMC) to comprehensively meet the needs of children and youth under 21 years of age with Behavioral Health(BH) and Home and Community Based Services (HCBS) needs …
1115 Waiver Amendment for Children – What the Waiver Amendment Changes
Add Medicaid state plan behavioral health services into MCO contractsTransition the 1915-c HCBS Waivers into an 1115 WaiverAllow mandatory enrollment of all children up to 21 years of ageAllow HCBS services outside MMC (FFS) for still exempt kidsChange HCBS benefit to new array and offer a single services array to all populations (foster care, medically fragile, behavioral health)Allow deeming for kids that don’t meet LOC HCBS eligibility
1115 Waiver Status – What’s the Issue?
The State recently received CMS reauthorization of its 1115 Waiver – this includes the authorization of Health Homes (there is no special authorization for Health Homes Serving Children)The state is reluctant to re-open any CMS review of the 1115 Waiver that was just re-authorized. This was evident last week when they withdrew the 1115 waiver amendment that would have authorized 30-day pre-release jail discharge eligibilityTimeline for kids’ behavioral health services’ transition won’t be adjusted, but a reasonable person would not expect a submission prior to Oct 2017 (the start of the federal fiscal year).
State Plan Amendments Submitted to CMS
Despite indicating that both the 1115 and State Plan Amendment applications to CMS would be held, DOH confirmed submission of two state plan benefit amendments just prior to January 1, 2017. The 2 amendment applications were for:to add Other Licensed Practitioner to the state plan behavioral health benefit ASAPto add Crisis Intervention, CPST, Psycho social rehab, Family Peer and Youth Peer Support by JulyAt November Kids’ MRT Subcommittee Meeting, it was stated that the 1115 Waiver and the SPA applications would be submitted to CMS as a “package” that one could not be implemented without approval for the other –
State Plan Amendment Services – same as 1915-c Waiver Services
One of the complexities with the SPA services is the fact that the state is trying to convert services only available currently under the 1915-c HCBS Waiver into state plan, FFS Medicaid benefits for all Medicaid eligible youth (crisis, family support, youth peer support)There is a definitely a question about whether the state can concurrently draw down federal match for the SAME services under FFS and Waiver reimbursement.This is why it was important that the 1115 Waiver submission be tied to the SPA submission – the 1115 Waiver would trigger a new array of Waiver services and allow the transition of the B2H, OMH and CAH Waiver programs to convert to the new service array – thereby avoiding the concurrent provision of State plan services similar to 1915-c services
1915-C Negotiations
As reported last month, OMH has gotten authorization to implement a transition plan to comply with the “firewall” version of Conflict of Interest for our existing 1915-c HCBS programThis will allow agencies to provide both ICC services and Waiver services if separate supervisory lines and firewalls are put into place.This agreement is contingent upon the situation being temporary until the 1915-c programs in New York transition to the 1115 HCBS Waiver array.Unbundled rates and rates for Youth Peer,VocEd and Supported Employment are still being reviewed by CMS, but OMH hopes to share on the February Monthly Waiver Webinar
RTF Pilot
Preliminary Description ~ OMH working on formal Pilot Description
$5 million State Share Support for RTF Pilots
OMH is committed to 2 phases of RTF ReformPhase 1: use funds to develop/increase alternative services capacity at RTFs willing to “suspend” beds – take beds off line; funds will be to fund operations and not drawn down federal match or be subject to state Medicaid rulesPhase 2: examine the rate methodology and make adjustments that support programmatic changes and administratively authorize operating changes through PARWe are awaiting a written description the fundable changes and what rules or standards the interested RTFs will be required to adhere to.
Role of Non-Profits in Democratic Process
Non-profits organizations support the participation of well-informed, experienced citizens in the democratic processNon-profit advocacy reflects the richness and diversity of community life to elected officialsThroughout our history, Americans have turned to nonprofit organizations to provide a strong, collective voice that informs and influences public policyIf not us, then who?
VAP and Safety Net Clinics
Funding notifications and Funding
DOH/CMS Negotiations Focused on Upper Payment Limit for Art 31
CMS rejected federal financial participation for the Art 31 VAP projects (40 clinics) because they believe New York is over the Upper Payment LimitsDOH and OMH will provide state funds to make up about 67.5% of the anticipated federal match to the VAP clinicsSome VAP clinic project may be notified that they are not meeting standards and the projects will be ended
The old Uncompensated Care program was denied federal financial participation for 2014 and 2015 because of U.P.LA new Safety Net Clinic program is being proposed for 2016 – OMH released the payment list of eligible clinicsOMH and DOH need clinics providers to improve CFR reporting in order to resolve UPL issues with CMS and ensure 2016 funds flow for the new Safety Net program
VBP in the kids’ world
Embrace, don’t ignore the changes
VBP for Kids
Children’s Clinical Advisory Group has not issued a recommendationThe CCAG is focusing in on 4 Key Measurements of child wellness and health, but will have to identify metrics:Improving developmental milestonesExhibiting social & emotional skillsMeasuring general health statusEvaluating family & caregiver capacity
OMH will issue $20 million for VBP Readiness
Children’s providers should not miss the opportunity to access funding to form IPAs, merger support fundingThe $20 million is the first of a 3-year allocation ($60 total)Applicants that are already working on sustainability business models will be eligible for larger grants and the majority of the funding;Applicants that are just beginning to work on VBP concepts will be eligible for smaller grants and less of the funding.
Collaborations
We’ve got a lot going on . . .
Contracting with the Coalition for Behavioral Health
Participate in developing advocacy positionsStaffing the Children’s Committee – first meeting of 2017 on February 23Evaluating further opportunities for the 2 organizationsAndrea will attend the CBH Advocacy Days – Feb. 6 & 7
Families Together Advocacy Training and Legislative Awareness
Did our joint Advocacy Training via Webinar on January 19 for family members and professional parentsCoalition Family Board Members to join Andrea at Leadership meetings as part of the FTNYS Day on February 14FTNYS Luncheon on Feb 14 is at 12 Noon – Awards to SenatorOrttand Assemblywoman Gunter at 1 pm.
Using Uniform Advocacy Information
Working with CHCANYs, other behavioral health and community providers to develop a single 25% carve-out request on the Statewide Healthcare Facility Transformation FundsWorking with ACL, MHANYs, the Coalition for Behavioral Health and NYSRA to develop the $50.5 million request for workforce needs of the mental health providersWorking with CCC, SCAA and others to request that funding restorations in the kids’ budget be used to support immediate capacity needs
2017 Coalition Meeting and Events
Webinar: Full Coalition MeetingDate:February1, 2017 , 10:00am - 11:30amNYC Site TBA: In Person & Webinar Full Coalition MeetingDate:April26, 2017, 10:00am - 1:00pmWebinar: Full Coalition MeetingDate:June28, 2017, 10:00am - 11:30pmWebinar: Full Coalition MeetingDate:September8, 2017, 10:00am - 11:30amAnnual Meeting of the CorporationDate: November 28 @ 10 am, Saratoga Springs
Webinar: Family Advocacy with FTNYS :Date:January 19th, 3pm - 4:00pmFamilies Together in New York State Family Advocacy Day with NYS Coalition:Date:February 14thAnnual Policy ForumDate:October 17th:  Location TBAOMH/Children's Behavioral Health Coalition  Staff Development Training ForumDate:November 28th - 29th 2017

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Association of NYS Youth Bureaus - Constant Contact